Bronchopleural fistula after pneumonectomy for lung cancer

Bronchopleural fistula (BPF) after pneumonectomy is a life-threateningcomplication. Over a period of 14 years (January 1980 to November 1993), 471 pneumonectomies were performed byone surgical team using a uniformsuture technique for primary lung cancer. Non-small cell lung canceraccounted for 451 cases and 20 cases were small cell cancer. All operationswere performed using a uniform hand suture technique. There were sevencases of BPF giving an incidence of 1.5%. All fistulas occurred within 15days postoperatively and there were no late fistulas. The bronchial stumpwas free of tumor in all cases. No fistula occurred in the 24 (5.1%)completion pneumonectomies. The experience of the surgeon was important asthe senior author performed 374 pneumonectomies with two fistulas (0.5%)while other surgeons in training performed 97 pneumonectomies with fivefistulas (5.1%). Bronchial dehiscence was confirmed by bronchoscopy in allcases and an attempt at resuturing the stump through the same thoracotomyincision was made within 2 days of the diagnosis. Closure was successful infive patients, while the other two developed fatal complications. Weconclude that suture closure to the bronchial stump after pneumonectomyprovides a cheap and reliable technique, it is applicable in all situationsand can be taught to surgeons in training with an acceptable risk. © 1995 by The University of Chicago.